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Updated: Jun 20, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Incremental Prognostic Impact of Quantitative Perfusion CMR and T1 Mapping in Patients with Heart Failure
Masafumi Takafuji1, Ching-Hui Sia2, Thomas Anderton2
1Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, United Kingdom; Department of Radiology, Mie University Hospital, Japan.
Insights
Combining myocardial perfusion and diffuse fibrosis assessments using cardiovascular magnetic resonance (CMR) improves heart failure (HF) prognosis prediction. These markers offer complementary information for better risk stratification in HF patients.
Area of Science:
- Cardiovascular Imaging
- Cardiac MRI
- Heart Failure Pathophysiology
Background:
- Myocardial perfusion and fibrosis are crucial in heart failure (HF) development.
- The combined prognostic value of these factors using cardiovascular magnetic resonance (CMR) is not well-established.
- Accurate risk stratification is vital for managing HF patients.
Purpose of the Study:
- To assess the incremental prognostic value of myocardial perfusion and diffuse fibrosis via CMR in HF patients.
- To determine if combining these parameters improves prediction of adverse outcomes.
- To enhance risk stratification strategies for heart failure management.
Main Methods:
- Prospective cohort of 677 HF patients undergoing CMR assessment.
- Quantification of myocardial blood flow (MBF), perfusion reserve (MPR), and extracellular volume fraction (ECV) using QP-CMR and T1 mapping.
- Primary endpoint: composite of HF hospitalization (HFH) and all-cause mortality, analyzed with Cox regression and global chi-square analysis.
Main Results:
- Lower MPR and higher native T1 and ECV were associated with adverse outcomes.
- Patients with both high-risk MPR and high-risk ECV showed the poorest prognosis (aHR 4.01).
- Adding ECV and MPR to conventional parameters significantly improved prognostic model discrimination (global chi-square increase).
Conclusions:
- QP-CMR (perfusion) and T1 mapping (fibrosis) provide complementary prognostic information in HF.
- Impaired myocardial perfusion is a significant risk marker, adding value to fibrosis assessment.
- Combined assessment enhances risk stratification for predicting adverse outcomes in heart failure.
Background:
Alterations in myocardial perfusion and fibrosis are key components in the pathophysiology of heart failure (HF). However, the incremental prognostic value of combining myocardial perfusion and fibrosis remains unclear. The purpose of this study was to evaluate the incremental prognostic value of myocardial perfusion and diffuse fibrosis as defined by cardiovascular magnetic resonance (CMR) in patients with HF.
Materials And Methods:
We collected data from prospectively recruited patients who were clinically diagnosed with HF and referred for CMR assessment between November 2017 to April 2024. Stress/rest myocardial blood flow (MBF) and perfusion reserve (MPR) were calculated from QP-CMR. Extracellular volume fraction (ECV) was calculated using T1 mapping. The primary endpoint was defined as a composite of HF hospitalization (HFH) and all-cause mortality, based on the timing of the first event. Univariate and multivariate Cox regression analysis, and global chi-square analysis were used to assess prognostic performance.
Results:
A total of 677 patients with HF (median (interquartile range) 63.2 (55.2-72.3) years; 436 male.) were enrolled. During a median 3.5 year follow-up, 109 patients (16.1%) reached the primary endpoints (59 deaths and 50 HFHs). Lower tertile of MPR [adjusted hazard ratio (aHR) 1.74 (95% confidence interval 1.18-2.56), p=0.005) and higher tertiles of native T1 [aHR 1.74 (1.16-2.59), p=0.007] and ECV [aHR 2.35 (1.58-3.49), p<0.001] were associated with the occurrence of the primary endpoint, whereas stress and rest MBF were not significantly associated. Patients exhibiting both high-risk MPR and high-risk ECV had the poorest prognosis [aHR 4.01 (2.28-7.03), p<0.001] whereas patients with only isolated high-risk MPR (aHR 1.74 (1.06-2.86), p=0.027), or high-risk ECV [aHR 2.36(1.36-4.09), p=0.002] demonstrated significantly worse prognoses than patients with both parameters within the low-risk range. Adding ECV to age, sex, and conventional parameters increased the global chi-square values from 33.79 to 50.34 (p<0.001), and further addition of MPR to 57.78 (p=0.006).
Conclusions:
QP-CMR and T1 mapping provide incremental, complementary prognostic information for predicting adverse outcomes in HF patients. Impaired myocardial perfusion may be an important marker for risk stratification in addition to myocardial fibrosis in HF patients.
